State health regulators have suspended the licenses of several abortion clinics owned by Associates in OB/GYN Care for the second time after an employee with no health care license or certification gave a patient a drug to induce an abortion at the Baltimore facility.
The same employee also performed an ultrasound on the woman, who was found to be 22 weeks pregnant with multiple fetuses, although the employee wasn't trained in the procedure, according to records released Friday by the Department of Health and Mental Hygiene. There was no physician at the clinic even though the woman had scheduled an appointment for a May 4 procedure.
The doctor who arrived at the clinic later that day refused to perform the abortion, saying "this facility is not equipped to do this procedure safely," according to the state records.
The state's Office of Health Care Quality investigated the facility and suspended its license after receiving an anonymous complaint about the patient's treatment on May 7. The agency also looked into operations at clinics owned by OB/GYN Care in Frederick, Silver Spring and Cheverly and suspended the licenses of those clinics as well.
The investigation found that it was common practice to administer the drug Misoprostol to induce an abortion in patients 11 weeks or more pregnant even if the patient has not been seen by a doctor and there was no physician at the clinic.
A spokeswoman for the clinics had not returned emails and calls Friday afternoon.
In a hearing earlier this month, OB/GYN Care admitted that treatment of the patient at the Baltimore facility and the protocol for using Misoprostol was improper, the state documents said. However, the firm blamed the problem on one physician and contested the license suspension.
The state declined to lift the suspension because OB/GYN Care did not provide "compelling evidence," to do so, according to state documents. OB/GYN Care can request an additional hearing to get the licenses reinstated.
The OB/GYN-run clinics in Baltimore, Landover and Silver Spring had their licenses suspended in March after a woman had complications following an abortion at the Baltimore facility and died at a local hospital. The woman had trouble breathing following, the state said, she suffered cardiac arrest at the clinic although the clinic disputed that assessment.
The patient suffered from a fatal heart condition, may have had defective heart valves and was probably in heart failure, wrote Melissa Shachnovitz, an administrator with OB/GYN, in a letter to state officials in March in response to the license suspension.
Although the woman's death was caused by underlying conditions and not the abortion, state investigators found the incident raised questions about whether doctors at the clinic could handle an abortion that goes wrong.
Health officials also cited other problems at the facilities at the time. At the Baltimore clinic, investigators found the physician who performed the abortion wasn't certified in CPR and the defibrillator at the clinic did not work. Investigators observed a patient at the Silver Spring clinic who was left alone for three minutes after waking up, leaving her at risk of falling. At the Landover location, the nurse did not know how to use the defibrillator or suction machine, and the defibrillator pads had expired.
The licenses were reinstated about two weeks later after OB/GYN Care submitted what is called a "plan of correction." A spokeswoman for the clinics said at the time that the company had corrected the issues at all three facilities. The defibrillators were fixed and staff retrained. They also performed emergency drills.
The suspensions were among the first actions the state took since adopting regulations for abortion clinics last year. Created in part because of a botched procedure at an Elkton clinic in 2010, the regulations allow the state to fine or shut down a clinic for violations related to anesthesia, emergency services, lab work and other areas.
Several delegates complained earlier this year that the state was not inspecting clinics quickly enough after a New York teacher died at a Germantown facility in February.
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